Gender Clinics
A gender clinic is a specialist service that assesses you before recommending hormones. Where informed consent treats the consent conversation as enough, a gender clinic usually wants one or more appointments with a clinician who explores your history and your goals, and a diagnosis, before hormones are started.
For most people in the UK this is the only route the NHS offers, and its defining feature is the wait. That is why so many people end up combining routes: on the NHS waiting list, private for the assessment or the prescription, and asking their GP to take over the prescribing to keep costs down.
I am not a doctor and I have not been through a gender clinic myself. Many of the British patients I coordinate for surgery in Bangkok have been through every version of this, and the same few points of confusion come up with nearly all of them. This page explains how the pieces fit.
On this page
How the assessment model works
At an assessment-led clinic, a clinician, often a psychologist, psychiatrist or specialist doctor, meets you to talk through your gender history, what you want from treatment, your general and mental health, and your support. The aim is to confirm a diagnosis of gender incongruence and that hormones are a sensible next step.
Some clinics do this in one appointment. Others want two, sometimes months apart, especially where the service works to older versions of the WPATH Standards of Care. After assessment, an endocrinologist or specialist doctor recommends a hormone plan, and blood tests follow.
The assessment is not a test you pass by saying the right things. It is a conversation, and being honest about doubts or a non-binary goal is fine. A good clinician adjusts the plan rather than rejecting you for it.
The NHS route in the UK
In England, you are referred to an NHS gender identity clinic (GIC) for adults, usually by your GP, and in some areas you can refer yourself. Scotland, Wales and Northern Ireland have their own services and referral routes.
Then you wait. The wait for a first appointment at most adult GICs has been several years, and for some clinics much longer. Published waiting times move, so check the current figure for the clinic you are referred to, and remember that the figure a clinic publishes is often based on who it is seeing now, not how long someone referred today will wait.
After assessment, the GIC recommends hormones and usually asks your GP to prescribe and do the blood tests under a shared care arrangement, with the GIC advising. Some newer NHS pilot services work more closely with primary care from the start.
The rules for under-18s in the UK have changed significantly in recent years and are still changing. This page is about adult services only.
As soon as you are sure you want to explore hormones
Get the referral in, even if you plan to go private. Your place on the NHS list is measured from the referral date, it costs nothing to hold, and it keeps an NHS option open for later.
Going private in the UK
Private gender clinics in the UK offer the same kind of assessment and prescribing, with waits of weeks or months rather than years. Some are led by GMC-registered specialists who used to work in NHS GICs; others are online services. Standards vary, and it is worth checking who the clinicians are and whether they are registered with the General Medical Council.
Private care typically means paying for the assessment, follow-up appointments, blood tests and the prescription itself, unless your GP agrees to take over prescribing. Cost and insurance has rough figures.
Going private does not remove you from the NHS list, and many people do both.
Shared care with your GP
Shared care is an arrangement where a specialist recommends a treatment and your GP agrees to prescribe it and do the routine monitoring. For NHS GIC patients it is the standard model. For private patients it is where the money is saved, because an NHS prescription costs a flat charge per item, or nothing in Scotland, Wales and Northern Ireland, rather than the private price.
GPs are not obliged to agree to shared care, and some decline, particularly when the recommending clinic is private or overseas. If yours does, ask for the reason in writing. Sometimes it is a practice policy, sometimes the GP wants a specific kind of letter or monitoring plan from the private clinic, and sometimes another GP in the same practice will take it on.
Before you commit to a private clinic
Ask your GP practice whether it will take on shared care from that particular clinic. Some practices have a list of private providers they will and will not work with, and it is much easier to know before you have paid for the assessment.
Bridging prescriptions
A bridging prescription is a GP prescribing hormones to someone who is waiting for specialist care, usually because they are already taking hormones without supervision. General Medical Council guidance allows it in limited circumstances, as a harm-reduction step, to avoid people carrying on with unmonitored hormones.
In practice it is patchy. GPs are cautious, and many want advice from a specialist before bridging. If you are already self-medicating, being open with your GP about exactly what you take and asking for blood tests is worth doing whether or not they will bridge, because it gets your health monitored.
Canada, Australia and the US
Canada. Most provinces allow family doctors and nurse practitioners to start hormones without referral to a specialist clinic, and many do on an informed-consent basis. Specialist gender clinics still exist, mostly for more complex cases or surgery referrals.
Australia. GPs can start hormones, and many use informed consent. Some people are referred to an endocrinologist or specialist gender service, especially where there are other health conditions. Access outside the cities can be thin.
The US. There is no single route. Some people see an endocrinologist, especially through a hospital's gender programme, where a letter or assessment may be required; others go to informed-consent clinics or telehealth. Insurers sometimes want a diagnosis and supporting letter before they will pay, even when the prescriber would not. State laws differ and change.
Everywhere, check the current rules. Access to gender-affirming care has moved in both directions in recent years.
Frequently asked questions
How long is the NHS gender clinic wait?
Several years for a first appointment at most adult clinics in England, longer at some. Published figures change, so check the current wait for your clinic. See the NHS route in the UK.
Can I go private and stay on the NHS list?
Yes. Going private does not remove you from the list, and many people do both. See going private in the UK.
Will my GP prescribe hormones a private clinic recommends?
Some will, under a shared care arrangement; GPs are not obliged to. Ask before you pay for a private assessment. See shared care with your GP.
What is a bridging prescription?
A GP prescribing hormones for someone waiting for specialist care, usually because they are already self-medicating, to keep them safe in the meantime. See bridging prescriptions.